Safety: Wound Care May Matter More Than Antibiotics
By NICHOLAS BAKALAR

Preventing infection in a wound may depend less on choosing the right antibiotic than on simply keeping it clean.

Researchers writing in the March issue of Pediatrics studied 200 children ages 6 months to 18 years. Each had a skin infection (generally from allergies, diaper rash or eczema), and 137 tested positive for methicillin-resistant staphylococcus, or MRSA. The subjects were randomly assigned to receive either clindamycin, an antibiotic that is effective against MRSA, or cephalexin, one that is less active against it.

The choice of antibiotic made no difference. After two to three days, 97 percent of the children on clindamycin showed improvement or complete healing, and so did 94 percent of those on cephalexin. Of the nine children whose infections were worse at this point, three were on clindamycin and six on cephalexin, an insignificant difference. There was a significantly lower rate of improvement among children under a year old, no matter which drug they were given.

The lead author, Dr. Aaron E. Chen, an assistant professor of pediatrics at Johns Hopkins when the study was done (he is now at the University of Pennsylvania), said he was not prepared to conclude that antibiotics are useless in treating these skin infections. But he added: “The most important part is good wound care, drainage of lesions and close follow-up. Antibiotics are probably not as important as we think they are, but we need larger studies to answer that question.”